Radiologists are not subject to Physician Quality Reporting Systems (PQRS) participation requirements for services performed at independent diagnostic testing facilities (IDTFs), according to a new guidance from the Centers for Medicare & Medicaid Services (CMS).

The June 5 directive reverses CMS’ decision in March that some services rendered by IDTFs meet the necessary billing methodology requirements to require radiologists and other medical practitioners to participate in PQRS to avoid future payment adjustments.
Under terms of the latest CMS guidance, radiologists who provide services for an IDTF (or on behalf of services provided by an IDTF) are not able to participate in PQRS. This means they will not receive PQRS payments adjustments for the years 2015-2018 for such services.

If services rendered under an IDTF received the PQRS payment adjustment on a 2015 Part B MPFS reimbursement, the claim will be automatically reprocessed to return the 1.5 percent adjustment, but affected radiologists can expect CMS to require several months to reprocess such claims and correct the payment adjustment.

Radiologists may not be exempt from PQRS for services performed in other clinical settings, however. PQRS participation is analyzed by unique individual National Provider Identifier (NPI) and Tax Identification Number (TIN) combinations, so radiologists who work for more than one organization will need to meet the PQRS reporting requirements to avoid future PQRS payment adjustment for any services billed to Medicare using their NPI that is under a non-IDTF arrangement.

For more information, contact the CMS QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or via e-mail addressed to qnetsupport@hcqis.org.

Assistance is available from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday.